Joint Commission’s ‘failure’ has senator asking how to make its inspections public

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 - Charles Grassley
U.S. Sen. Chuck Grassley, R-Iowa

In a letter to CMS, Senate Judiciary Committee Chairman Chuck Grassley, R-Iowa, asked what legal barriers are standing in the way of the agency making hospital inspections done by private accrediting organizations public, reigniting debate over a regulatory change hospitals strongly opposed earlier this year.

Grassley singled out the largest private accreditor, the Joint Commission, in his letter, saying it “appears to be unable to aggressively enforce the necessary standards on all facilities.” In one example, he said the commission failed to provide the information he requested on Universal Health Services’ Shadow Mountain psychiatric hospital in Tulsa, Oklahoma, which was alleged to have a history of abuse and neglect of patients in a Buzzfeed News story published in April. According to Grassley, the commission refused to detail the facility’s performance issues, if and how problems were fixed or provide the inspection reports.

He also cited a Wall Street Journal story about Cooley Dickinson Hospital in Northamption, Massachusetts, which was given the “Gold Seal of Approval” by the Joint Commission even after CMS threatened to cut it off over safety problems which led to preventable patient deaths. The “failure” by the commission to either identify or punish an unsafe facility, Grassley wrote, may be remedied by making currently private inspection reports by accrediting organizations available to the public.

“Making facility inspections reports public may go a long way to providing the necessary additional information for patients and their families to make informed decisions about where to seek care,” Grassley said.

CMS had suggested doing just that, slipping in such a provision 1,400 pages into the proposed inpatient payment rule for 2018. Hospitals and accrediting organizations, including the Joint Commission, came out strongly against the idea, with the commission arguing at the time it would increase costs on health systems, expose proprietary information and create a culture of adversity between the inspectors and healthcare organizations.

“We do not shy away from transparency but we stand firmly for quality improvement and patient safety,” wrote Joint Commission President and CEO Mark Chassin, MD, MPP, MPH.

CMS took the provision out of the final rule, apparently swayed by the argument the Social Security Act prohibits it from disclosing what’s in those reports or compelling accreditors to do so. Grassley asked for CMS to explain what would need to be changed in the law to allow those inspection reports to be made public, asking for a response by Oct. 2.

In a response to Grassley’s letter, the Joint Commission defended its reputation and said it’s open to efforts which support both transparency to consumers and confidentiality for healthcare organizations.

“We all want a health care system that consistently delivers the highest quality of care to all patients and enables health care providers to continually improve their performance,” Joint Commission spokesperson Elizabeth Zhani told HealthExec. “The Joint Commission steadfastly supports putting valid, useful data on quality of care in the hands of the public. We have been doing just that for more than 20 years. We and others continue to support dialogue between government and federal stakeholders and accreditation organizations to identify a more effective strategy for educating the public while ensuring necessary confidentiality for health care quality improvement. This balance between disclosure and confidentiality is a foundation of accreditation and quality improvement not only in health care but in nearly all other industries.”